High-dose-rate plesiotherapy with customized molds in non-melanoma skin cancer: efficacy and safety at 10 years—single institution experience

PurposeOur center adopted high-dose-rate brachytherapy with surface applicators (plesiotherapy) in 2008, creating custom molds to treat irregular areas. This study describes the efficacy and safety outcomes after extensive follow-up in the patients.Methods/patientsWe planned the treatment using two computed tomography (CT) scans: the first to delineate the lesion and the second after placing the thermoplastic mold. Fusing the two CT images enables planning of the target volume and pinpointing, where the catheters are in the mold.ResultsSeventy patients received plesiotherapy, either exclusively or following excision in patients with risk factors for recurrence. Those receiving plesiotherapy alone showed a complete response rate of 95.8%, and recurrences occurred in 5.7% at a mean follow-up of 96.2 months. Chronic toxicity appeared in 26.6% of patients, but severity was limited to grade 1 or 2.ConclusionsHigh-dose-rate brachytherapy with customized molds yields a high rate of complete response, with long-term recurrence rates in line with similar studies and an acceptable toxicity rate.

High-dose-rate plesiotherapy with customized molds in non-melanoma skin cancer: efficacy and safety at 10 years-single institution experience.

PURPOSE: Our center adopted high-dose-rate brachytherapy with surface applicators (plesiotherapy) in 2008, creating custom molds to treat irregular areas. This study describes the efficacy and safety outcomes after extensive follow-up in the patients. METHODS/PATIENTS: We planned the treatment using two computed tomography (CT) scans: the first to delineate the lesion and the second after placing the thermoplastic mold. Fusing the two CT images enables planning of the target volume and pinpointing, where the catheters are in the mold. RESULTS: Seventy patients received plesiotherapy, either exclusively or following excision in patients with risk factors for recurrence. Those receiving plesiotherapy alone showed a complete response rate of 95.8%, and recurrences occurred in 5.7% at a mean follow-up of 96.2 months. Chronic toxicity appeared in 26.6% of patients, but severity was limited to grade 1 or 2. CONCLUSIONS: High-dose-rate brachytherapy with customized molds yields a high rate of complete response, with long-term recurrence rates in line with similar studies and an acceptable toxicity rate.

Prevention of acute radiation enteritis: efficacy and tolerance of glutamine.

PURPOSE Our primary endpoint is to determine the effect of L-glutamine Resource (Nestlé Healthcare Nutrition) in the prevention of induced enteritis after pelvic radiotherapy (RT). METHODS We observed the incidence of diarrhoea during and after pelvic radiation therapy in patients receiving L-glutamine Resource (Nestlé Healthcare Nutrition) supplementation. To assess results, patients were stratified according to prior treatment (prior surgery and/or concomitant chemotherapy, or no prior or concomitant treatment). RESULTS Incidence of diarrhoea observed is similar to published series in which glutamine is not administered. Grade 1 intestinal toxicity was observed in 4 patients (15.4%), grade 2 in 10 patients (38.4%) and grade 3 in 5 patients (19.2%). Mean dose of RT at the start of enteritis was 23.55 Gy (12-40). No grade 4 toxicity occurred and in 7 patients (27%) no toxicity was reported. No differences in toxicity incidence were observed between RT dose levels. CONCLUSIONS Administration of glutamine to patients during pelvic RT does not appear to prevent the incidence of enteritis (diarrhoea). No differences were observed between patients who underwent concomitant chemotherapy (where you would expect an increase in toxicity) and those who did not.

Prevention of acute radiation enteritis: efficacy and tolerance of glutamine

PURPOSE Our primary endpoint is to determine the effect of L-glutamine Resource (Nestlé Healthcare Nutrition) in the prevention of induced enteritis after pelvic radiotherapy (RT). METHODS We observed the incidence of diarrhoea during and after pelvic radiation therapy in patients receiving L-glutamine Resource (Nestlé Healthcare Nutrition) supplementation. To assess results, patients were stratified according to prior treatment (prior surgery and/or concomitant chemotherapy, or no prior or concomitant treatment). RESULTS Incidence of diarrhoea observed is similar to published series in which glutamine is not administered. Grade 1 intestinal toxicity was observed in 4 patients (15.4%), grade 2 in 10 patients (38.4%) and grade 3 in 5 patients (19.2%). Mean dose of RT at the start of enteritis was 23.55 Gy (12-40). No grade 4 toxicity occurred and in 7 patients (27%) no toxicity was reported. No differences in toxicity incidence were observed between RT dose levels. CONCLUSIONS Administration of glutamine to patients during pelvic RT does not appear to prevent the incidence of enteritis (diarrhoea). No differences were observed between patients who underwent concomitant chemotherapy (where you would expect an increase in toxicity) and those who did not (AU)

Neuroendocrine small cell carcinoma of the uterine cervix

Neuroendocrine small cell carcinoma of the uterine cervix (SCC) is a rare disease that mixes clinical and biological characteristics of both cervical neoplasms and neuroendocrine small cell cancer. The prognosis is poor and the optimal treatment has not yet been clarified. Multimodality treatment, with surgery and concurrent chemoradiation has recently been shown to improve local control and survival rates (AU)

Use of radiation treatment units in breast cancer. Changes in the last 15 years.

INTRODUCTION: Advances in diagnosis and treatment in oncology combined with technical advances in radiotherapy have resulted in qualitative and quantitative changes in the use of radiation to treat breast cancer. OBJECTIVE: The objective was to analyse changes in radiation indications from 1990 to the present time and their consequences in the use of treatments units. METHODS AND MATERIAL: From January 1990 to December 2005, 4545 radiation treatments for breast cancer were performed, classified as radical after conservative surgery, radical after mastectomy or palliative. Data are presented as relative frequencies and as 3-year period groups. RESULTS: An increase in the proportion of treatments for breast cancer and in treatment unit use distribution is observed. Radical treatments have increased over time, ranging from 55% in the first 3-year period group to 82% in the last one. Unit treatment distribution analysis is similar, but with a less important increase, rising from 85% to 95%. A rise in conservative treatment is also observed, from 43% to 75%. CONCLUSIONS: An increase in breast cancer incidence is observed and there was also an increase in irradiation after conservative treatment. On the contrary, probably due to the rise in the use of systemic treatments, a decrease in postmastectomy irradiation and palliative treatments is shown.

Use of radiation treatment units in breast cancer. Changes in the last 15 years

INTRODUCTION: Advances in diagnosis and treatment in oncology combined with technical advances in radiotherapy have resulted in qualitative and quantitative changes in the use of radiation to treat breast cancer. OBJECTIVE: The objective was to analyse changes in radiation indications from 1990 to the present time and their consequences in the use of treatments units.METHODS AND MATERIAL: From January 1990 to December 2005, 4545 radiation treatments for breast cancer were performed, classified as radical after conservative surgery, radical after mastectomy or palliative. Data are presented as relative frequencies and as 3-year period groups. RESULTS: An increase in the proportion of treatments for breast cancer and in treatment unit use distribution is observed. Radical treatments have increased over time, ranging from 55% in the first 3-year period group to 82% in the last one. Unit treatment distribution analysis is similar, but with a less important increase, rising from 85% to 95%. A rise in conservative treatment is also observed, from 43% to 75%. CONCLUSIONS: An increase in breast cancer incidence is observed and there was also an increase in irradiation after conservative treatment. On the contrary, probably due to the rise in the use of systemic treatments, a decrease in postmastectomy irradiation and palliative treatments is shown (AU)

Risk factors of local relapse in breast cancer: the importance of age.

PURPOSE: The objective of the present analysis is to know what risk factors affect local relapse in breast cancer. METHODS AND MATERIALS: A total of 1165 patients diagnosed with early breast cancer were included. Boost dose was modulated in the presence of risk factors. Patients with one risk factor received a boost of 10 Gy, while 20 Gy was administered in those with two risk factors. RESULTS: Median follow-up was of 60 months. Mean age of patients was 56.7+/-10.8 years. Local risk factors were present in 82.8% of patients. The probability of remaining free of local recurrence at 5 and 10 years is 97.7% (CI 95%: 96.7-98.7) and 94.5% (CI 95%: 92.1-96.9). Only age showed an impact in local relapse on multivariate analysis. Patients 40 years or younger had a relative risk of local relapse of 5.27 and patients 41-50 of 3.7 with respect to patients older than 50 years. CONCLUSION: Patients 40 years or younger have a higher risk of local failure than older patients. Other risk factors such as tumour size, intraductal carcinoma or margin status could be masked by an increase of radiation dose.

Risk factors of local relapse in breast cancer: the importance of age

PURPOSE: The objective of the present analysis is to know what risk factors affect local relapse in breast cancer. METHODS AND MATERIALS: A total of 1165 patients diagnosed with early breast cancer were included. Boost dose was modulated in the presence of risk factors. Patients with one risk factor received a boost of 10 Gy, while 20 Gy was administered in those with two risk factors. RESULTS: Median follow-up was of 60 months. Mean age of patients was 56.7+/-10.8 years. Local risk factors were present in 82.8% of patients. The probability of remaining free of local recurrence at 5 and 10 years is 97.7% (CI 95%: 96.7-98.7) and 94.5% (CI 95%: 92.1-96.9). Only age showed an impact in local relapse on multivariate analysis. Patients 40 years or younger had a relative risk of local relapse of 5.27 and patients 41-50 of 3.7 with respect to patients older than 50 years. CONCLUSION: Patients 40 years or younger have a higher risk of local failure than older patients. Other risk factors such as tumour size, intraductal carcinoma or margin status could be masked by an increase of radiation dose (AU)